Wound Care Certification Exam Wound Care Certification Atypical Wound Etiologies 2 — Questions and Answers
Question 1: A patient with end-stage renal disease on dialysis develops extremely painful, stellate-shaped necrotic lesions on the thighs and abdomen. Skin biopsy reveals calcium deposits in small vessel walls. Which condition is most likely?
- Pyoderma gangrenosum
- Calciphylaxis (Correct answer)
- Livedoid vasculopathy
- Martorell ulcer
Correct answer: Calciphylaxis
Calciphylaxis is characterized by vascular calcification and occlusion causing painful necrotic skin lesions, most commonly in patients with renal failure.
Question 2: Which laboratory finding is most consistently associated with calciphylaxis?
- Elevated ESR
- Elevated calcium-phosphate product (>55 mg²/dL²) (Correct answer)
- Low serum albumin
- Elevated D-dimer
Correct answer: Elevated calcium-phosphate product (>55 mg²/dL²)
An elevated calcium-phosphate product above 55 mg²/dL² promotes precipitation of calcium salts in vessel walls, a hallmark of calciphylaxis.
Question 3: A wound clinician notes a wound with a violaceous, undermined border that rapidly expands despite standard wound care. The patient has a history of inflammatory bowel disease. The most appropriate next step is to:
- Debride aggressively to remove necrotic tissue
- Start immunosuppressive therapy and minimize debridement (Correct answer)
- Apply compression bandaging
- Order venous duplex ultrasound
Correct answer: Start immunosuppressive therapy and minimize debridement
Pyoderma gangrenosum exhibits pathergy, meaning aggressive debridement worsens the wound; immunosuppression with corticosteroids is the cornerstone of treatment.
Question 4: Livedoid vasculopathy (atrophie blanche) is best characterized by which of the following wound presentations?
- Large necrotic plaques on the abdomen
- Ivory-white stellate scars surrounded by hyperpigmentation on the lower leg (Correct answer)
- Punched-out ulcers on the heel
- Nodular lesions along lymphatic channels
Correct answer: Ivory-white stellate scars surrounded by hyperpigmentation on the lower leg
Livedoid vasculopathy produces small, painful ulcers on the lower legs that heal leaving characteristic ivory-white (atrophie blanche) scars with peripheral hyperpigmentation.
Question 5: A patient presents with a non-healing leg ulcer, sickle cell disease, and no signs of venous or arterial insufficiency. The ulcer is located on the medial malleolus. The primary etiology of this wound is most likely:
- Venous hypertension
- Microvascular occlusion from sickled red blood cells (Correct answer)
- Peripheral arterial disease
- Trauma
Correct answer: Microvascular occlusion from sickled red blood cells
Sickle cell ulcers result from microvascular occlusion, hemolysis, and poor oxygen delivery, and characteristically occur over the medial or lateral malleolus.
Question 6: Which of the following is the most appropriate initial treatment for a hypertensive ischemic ulcer (Martorell ulcer)?
- Compression therapy
- Aggressive surgical debridement only
- Strict blood pressure control combined with wound care (Correct answer)
- Antibiotic therapy alone
Correct answer: Strict blood pressure control combined with wound care
Martorell ulcers are caused by hypertension-induced arteriolar occlusion; the primary intervention is aggressive blood pressure management alongside wound care.
Question 7: A patient undergoing radiation therapy for pelvic cancer develops a non-healing wound in the irradiated field with pale, fibrotic tissue and poor granulation. This wound is best categorized as:
- Arterial ulcer
- Radiation-induced wound (Correct answer)
- Pressure injury stage 4
- Fungating malignant wound
Correct answer: Radiation-induced wound
Radiation-induced wounds result from progressive obliterative endarteritis, fibrosis, and impaired angiogenesis in previously irradiated tissue.
Wound Care Certification Exam Wound Care Certification Atypical Wound Etiologies 2
A patient with end-stage renal disease on dialysis develops extremely painful, stellate-shaped necrotic lesions on the thighs and abdomen.
Skin biopsy reveals calcium deposits in small vessel walls.
Which condition is most likely?